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Web-based cognitive behavioral therapy effective for insomnia

Web-based cognitive behavioral therapy improved insomnia severity, sleep-onset latency, and wake after sleep onset among individuals with chronic insomnia.

“Although there is strong empirical support for [CBT for insomnia (CBT-I)], the lack of trained clinicians and expense, while cost-effective, limits access. To overcome these barriers, innovative methods of delivering CBT-I have been developed, and initial evidence supports their feasibility and efficacy,” Lee M. Ritterband, PhD, of Virginia School of Medicine, Charlottesville, and colleagues wrote. “To date, internet-based trials with published outcomes have been small, homogeneous, and limited in their generalizability and have excluded individuals with insomnia co-occurring with medical and psychiatric disorders.”

To assess a web-based, automated CBT-I intervention, Sleep Healthy Using the Internet (SHUTi), for short-term (9 weeks) and long-term (1 year) improvements in insomnia, researchers conducted a randomized clinical trial among 303 adults with chronic insomnia. Study participants received SHUTi (n = 151) or an online patient education program (n = 152) for 6 weeks. The study cohort had a mean age of 43.28 years.

Participants who received SHUTi exhibited greater improvement in insomnia severity (P < .001), sleep-onset latency (P < .001) and wake after sleep onset (P < .001), compared with those who received online education.

Treatment effects were maintained at 1-year follow-up, with 56.6% of the SHUTi group achieving remission status and 69.7% identified as treatment responders at 1 year based on Insomnia Severity Index data.

Sleep efficiency, number of awakenings and sleep quality also significantly improved among the SHUTi group.

“On the whole, the findings suggest that SHUTi is a promising treatment option for patients with insomnia. These findings and the potential for rapid widespread use demand that we address a critical question: ‘Should internet CBT-I be the first-line treatment for all patients with insomnia?’” Andrew D. Krystal, MD, MS, of University of California, San Francisco, and Aric A. Prather, PhD, of Duke University School of Medicine, wrote in an accompanying editorial. “Despite reasons for restraint, it seems inevitable that internet CBT-I will be increasingly used as a first-line insomnia intervention. It also seems likely that the medical community may have little influence on whether, when, and how this occurs. It is unknown to what extent those who provide treatment will play a role in directing individuals with insomnia to efficacious internet-based CBT-I system. In this regard, the article by Ritterband and coworkers suggests that many of those who choose SHUti will experience lasting improvement.” – by Amanda Oldt

Disclosure: Ritterband, Thorndike, Gonder-Frederick, and Morin reported having equity ownership in BeHealth Solutions LLC, a company that develops and makes available products related to the research reported in this article. Please see the study for a full list of relevant financial disclosures.